The County of Essex has declared a local emergency in response to ongoing delays faced by EMS in offloading patients at area hospitals.
The declaration allows the County to bring together its Community Control Group - which includes senior leadership at the County along with local hospitals, the dispatch system and Ontario Health -- to discuss what needs to be done and what support needs to be requested from the province.
Essex Windsor EMS has been faced with consistent Code Blacks since 2020, a term used to describe when there are no ambulances available to respond to emergency calls because paramedics are waiting at a hospital to offload the patient.
As of Oct. 14, instances of Code Black, which are calculated in minutes, totalled 491 minutes during the first two weeks of October compared to 116 minutes in all of September, 77 minutes in August and 31 minutes in July.
Bruce Krauter, Chief of Essex Windsor EMS, speaks at a news conference to address a local emergency being declared due to ongoing delays faced by EMS in offloading patients at area hospitals. Oct. 17, 2022 (Photo by Rusty Thomson)
Bruce Krauter, Chief of Essex Windsor EMS, says their hospital partners are not to blame for the situation and that they work their hospital partners to reduce offload delays. He says the causes of offload delays are complex and related to hospital capacity, patient flow and a lack of primary care providers which causes increased usage of 9-1-1.
Essex Windsor EMS is calling for several changes to address the situation:
- the ability to have paramedics treat and refer low acuity patients on-scene to divert away from the emergency department
- the ability to place a clinician in the dispatch centre to triage on the phone and refer patients to alternate care
- primary care providers to have open hours to be conducive to the public need
- recognize offload delays as a public health risk
- create incentives for hospitals to meet 30-minute offload targets and enforce consequences for those that fail to meet the targets
- require hospitals to triage patients brought in by paramedics as a first priority – every time
- implement Fit-to-Sit programs: Allow low acuity patients brought in by ambulance to go to the waiting room so paramedics can get back on the road
- require hospitals to take a whole-hospital approach and develop escalation plans mobilizing all levels of the hospital to deal with emergency department surges and offload delays
- create standardized measurements and reporting between hospitals and paramedics to ensure consistent and accurate data collection to inform decisions
Krauter believes having a clinician working in the dispatch centre would help determine the needs of a low acuity patient.
"They can talk to them on the phone and determine if they need to go to the hospital, and where they can get them to proper care at the right time and place. Most of the time the emergency department may not be the right place for them to go to," he says.
Krauter says they want paramedics to be able treat, release and refer on-scene for patients in a non-life threatening scenario.
"Right now under the Ambulance Act, we must transport people to the emergency department," he says. "We want the leeway and openness that if we can transport them, or have them referred to their primary care provider, a pharamcy, so they can seek care elsewhere than the emergency department. This way it creates capacity."
Krauter says another big issue is that they're 'bed blocked' right now due to capacity issues at the hospitals.
"Currently we have, I believe, 40 to 50 patients in he emergency department waiting for beds upstairs in the hospital. Those are 40 beds that EMS could use to offload patients. We have to find some place for their patients to go to await admission into the hospital other than the emergency department," he adds.
Windsor Regional Hospital reported that as of 9:45 a.m. on Oct. 17, there were 44 patients in the Emergency Departments who have been admitted to hospital but waiting for an in-patient bed to become available, 22 at the Ouellette Campus and 20 at the Met Campus.
On top of that figure, the hospital is also reporting:
- the occupancy level for medical/surgical patients at the Ouellette Campus is at 106%
- the occupancy level for medical/surgical patients at the Met Campus is at 107%
- there are 44 patients in the Emergency Departments who have been admitted to hospital but waiting for an in-patient bed to become available (22 at Ouellette Campus and 20 at Met Campus)
- there are a total of 42 Alternate Level of care (ALC) patients in hospital (14 at Ouellette Campus and 28 at Met Campus). Of the 42 ALC, 27 are awaiting a LTC bed to become available.